Geleneksel ve Dijital Ölçülerin Dezenfeksiyon ve Sterilizasyon İşlemleri

Seda Cengiz; Feyza Aksu Olcay

Review

Disinfection and Sterilization Processes of Analog and Digital Impressions

Year 2021, Volume: 3 Issue: 2, 52 - 65, 30.06.2021

Seda Cengiz , Feyza Aksu Olcay

Abstract

Prosthetic specialists, dental staff and dental technicians are faced with many infections that can be transmitted from patients due to the materials and applications used in prosthetic dental treatment. During prosthetic procedures causes cross contamination between the clinic and the laboratory, transporting impression materials taken from the patient's mouth to the laboratory without being disinfected. In order to prevent contamination, it is recommended that the measurements taken from the patients are disinfected and forwarded to the technicians. However, the disinfection material and methods to be used may affect the properties of the impression material. The purpose of this review is to examine the disinfection and sterilization methods of digital and traditional analog impressions.

Keywords

disinfection, analog impression, digital impression

References

1. al-Omari WM, Jones JC, Hart P. A microbiological investigation following the disinfection of alginate and addition cured silicone rubber impression materials. Eur J Prosthodont Restor Dent. 1998;6(3):97-101.
2. Drennon DG, Johnson GH, Powell GL. The accuracy and efficacy of disinfection by spray atomization on elastomeric impressions. J Prosthet Dent. 1989;62(4):468-75.
3. Westerholm HS, 2nd, Bradley DV, Jr., Schwartz RS. Efficacy of various spray disinfectants on irreversible hydrocolloid impressions. Int J Prosthodont. 1992;5(1):47-54.
4. Taylor RL, Wright PS, Maryan C. Disinfection procedures: their effect on the dimensional accuracy and surface quality of irreversible hydrocolloid impression materials and gypsum casts. Dent Mater. 2002;18(2):103-10.
5. Egusa H, Watamoto T, Matsumoto T, Abe K, Kobayashi M, Akashi Y, et al. Clinical evaluation of the efficacy of removing microorganisms to disinfect patient-derived dental impressions. Int J Prosthodont. 2008;21(6):531-8.
6. Kotsiomiti E, Tzialla A, Hatjivasiliou K. Accuracy and stability of impression materials subjected to chemical disinfection - a literature review. J Oral Rehabil. 2008;35(4):291-9.
7. Külekçi G. Dişhekimliğinde bulaşabilir enfeksiyonlar. Dişhekimliğinde Klinik 2000; 13: 69-76.
8. Georgescu CE, Sakaug N, Patrascu I. Cross Infection in Dentistry. Roum Biotechnol Lett 2002;7: 861-868.
9. Akçaboy C, Suca S. Ölçü maddeleri ve klinik uygulamaları. 1. baskı, Gazi Üniversitesi Diş Hekimliği Fakültesi, Ankara, 1993, 129-133.
10. Akpınar YZ, Uzun İH, Yılmaz B, Tatar N. Protetik tedavilerde çapraz enfeksiyon kontrolü. Atatürk Üniv. Diş Hek. Fak. Derg. 2013; Suppl 7: 142-149. 11. Al-Jabrah O, Al-Shumailan Y, Al-Rashdan M. Antimicrobial effect of 4 disinfectants on alginate, polyether, and polyvinyl siloxane impression materials. Int J Prosthodont. 2007; 20: 299-307.
12. Almortadi N, Chadwick RG. Disinfection of dental impressions - compliance to accepted standards. Br Dent J. 2010; 209: 607-611.
13. Sofou A, Larsen T, Fiehn NE, Owall B. Contamination level of alginate impressions arriving at a dental laboratory. Clin Oral Investig. 2002; 6:161-165.
14. Acar N. Diş Hekimliğinde Sterilizasyon Kontrolü ve Önemi. 5. Ulusal Sterilizasyon Dezenfeksiyon Kongresi 2007.
15. Hargreaves KM, Cohen S. RC. Pathways of the pulp. 10th ed., Mosby, St Louis, 2002, 124-134.
16. Dezenfeksiyon, Antisepsi, Sterilizasyon Derneği (DAS). Sterilizasyon Dezenfeksiyon Rehberi 2011;18-28.
17. Naylor WP. Infection control in fixed prosthodontics. Dent Clin North Am 1992; 36: 809-31.
18. Chidambaranathan AS, Balasubramanium M. Comprehensive review and comparison of the disinfection techniques currently available in the literature. J Prosthodont. 2019;28(2):849-56.
19. Arıkan S. Temizlik, dezenfeksiyon ve sterilizasyon Hastane İnfeksiyonları Dergisi. 1997; 1: 61-68.
20. Abbasoğlu U. Dezenfektanlar: Sınıflama ve Amaca Uygun Kullanım Alanları. 6. Ulusal Sterilizasyon Dezenfeksiyon Kongresi. 2009.
21. Centers for Diseases Control and Prevention: Guidelines for environmental infection control in health care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC), CDC, Atlanta GA (2003).
22. Decontamination and Disinfection. 2008 Elektronik adresi: http://ehs.columbia.edu/decon.html
23. Bhat, V., Shenoy, K., Shetty, S. Evaluation of efficacy of microwave oven irradiation in disinfection of patient derived dental cast. Int J Infect Cont. 2012;8(3):1-4.
24. Herrera, S. P., & Merchant, V. A. Dimensional stability of dental impressions after immersion disinfection. J Am Dent Assoc. 1986;113(3):419-22.
25. Chia WK, Stevens L, Basford KE, Randell DM. Dimensional change of impressions on sterilization. Aust Dent J. 1990;35(1):23-6.
26. Jagger DC, Al Jabra O, Harrison A, Vowles RW, McNally L. The effect of a range of disinfectants on the dimensional accuracy of some impression materials. Eur J Prosthodont Restor Dent. 2004;12(4):154-60.
27. Johnson GH, Chellis KD, Gordon GE, Lepe X. Dimensional stability and detail reproduction of irreversible hydrocolloid and elastomeric impressions disinfected by immersion. J Prosthet Dent. 1998;79(4):446-53.
28. Infection control recommendations for the dental office and the dental laboratory. ADA Council on Scientific Affairs and ADA Council on Dental Practice. J Am Dent Assoc. 1996;127(5):672-80.
29. Samaranayake LP, Hunjan M, Jennings KJ. Carriage of oral flora on irreversible hydrocolloid and elastomeric impression materials. J Prosthet Dent. 1991;65(2):244-9.
30. Amin WM, Al-Ali MH, Al Tarawneh SK, Taha ST, Saleh MW, Ereifij N. The effects of disinfectants on dimensional accuracy and surface quality of impression materials and gypsum casts. J Clin Med Res. 2009;1(2):81-9.
31. Ishida H, Nahara Y, Tamamoto M, Hamada T. The fungicidal effect of ultraviolet light on impression materials. J Prosthet Dent. 1991;65:532-535.
32. S. Ud Din, N. Noor, S. Humayoun, S. Khalid, S. Parker, M. Patel Tensile strength of novel experimental hydrophilic vinyl polysiloxane impression materials compared to control and commercial vps impression materials. J Islamabad Med Dent Coll. 2018;7(1):67-72.
33. T.A. Hamalian, E. Nasr, J.J. Chidiac. Impression materials in fixed prosthodontics: influence of choice on clinical procedure J Prosthodont. 2011;20:153-160.
34. U. Nassar, A. Oko, S. Adeeb, M. El-Rich, C. Flores-Mir. An in vitro study on the dimensional stability of a vinyl polyether silicone impression material over a prolonged storage period. J Prosthet Dent. 2013;109:172-178.
35. S. Chen, W. Liang, F. Chen. Factors affecting the accuracy of elastometric impression materials. J Dent. 2004;32(8):603-609.
36. K. Grundke, S. Michel, G. Knispel, A. Grundler. Wettability of silicone and polyether impression materials: characterization by surface tension and contact angle measurements. Colloids Surf A Physicochem Eng Asp. 2008;317(1-3):598-609.
37. F. Luo, G. Hong, T. Wang, L. Jia, J.-Y. Chen, L. Suo, et al. Static and dynamic evaluations of the wettability of commercial vinyl polysiloxane impression materials for artificial saliva. Dent Mater J. 2018;37(5):818-824.
38. S. Ud Din, S. Parker, M. Braden, P. Tomlins, M. Patel. Experimental hydrophilic vinyl polysiloxane (VPS) impression materials incorporating a novel surfactant compared with commercial VPS. Dent Mater J. 2017;33(8):301-309.
39. S. Younis, M. Ijaz, S. Ibrahim, A. Aslam. Wettability and hydrophillicity of vinyl polysiloxane impression material. Pak Oral Dent J. 2018;38:390-392.
40. S.V. Nimonkar, V.M. Belkhode, S. Godbole, P.V. Nimonkar, T. Dahane, S. Sathe. Comparative evaluation of the effect of chemical disinfectants and ultraviolet disinfection on dimensional stability of the polyvinyl siloxane impressions. J Int Soc Prev Community Dent. 2019;9:152.
41. X. Lepe, G.H. Johnson, J.C. Berg, T.C. Aw, G.S. Stroh. Wettability, imbibition, and mass change of disinfected low-viscosity impression materials. J Prosthet Dent. 2002;88(3):268-276.
42. A. Thomas, K. Muniandy. Absorption and desorption of water in rubbers. Polymer. 1987;28(3):408-415.
43. G. Soganci, D. Cinar, A. Caglar, A. Yagiz. 3D evaluation of the effect of disinfectants on dimensional accuracy and stability of two elastomeric impression materials. Dent Mater J. 2018;37(4):675-684.
44. E. Kotsiomiti, A. Tzialla, K. Hatjivasiliou. Accuracy and stability of impression materials subjected to chemical disinfection – a literature review. J Oral Rehabil. 2008;35(4):291-299.
45. Estafanous EW, Palenik CJ, Platt JA. Disinfection of bacterially contaminated hydrophilic PVS impression materials. J Prosthodont. 2012;21:16-21.
46. McIntosh, K., Hirsch, M. S., Bloom, A. Coronavirus disease 2019 (COVID-19). UpToDate Hirsch MS Bloom. 2020;5:1-1.
47. Vatansever F, Ferraresi C, de Sousa MVP, Yin R, Rineh A, Sharma SK. Can biowarfare agents be defeated with light? Virulence. 2013;4(8):796-825.
48. Andersen, B. M., Bånrud, H., Bøe, E., Bjordal, O., Drangsholt, F. Comparison of UV C light and chemicals for disinfection of surfaces in hospital isolation units. Infect Control Hosp Epidemiol. 2006;27(7):729-34.
49. Kohn, W. G., Collins, A. S., Cleveland, J. L., Harte, J. A., Eklund, K. J., Malvitz, D. M. Guidelines for infection control in dental health-care settings. 2003;52(17):1-61.
50. Guidelines for infection control in the dental office and the commercial dental laboratory. Council on Dental Therapeutics. Council on Prosthetic Services and Dental Laboratory Relations. J Am Dent Assoc. 1985;110(6):969-72.
51. Berg E, Nielsen O, Skaug N. High-level microwave disinfection of dental gypsum casts. Int J Prosthodont. 2005;18(6):520-5.
52. Barenghi L, Barenghi A, Cadeo C, Di Blasio AJBri. Innovation by Computer-Aided Design/Computer-Aided Manufacturing Technology: A Look at Infection Prevention in Dental Settings. Biomed Research Internatıonal. 2019;1-15.
53. Gallardo YR, Bohner L, Tortamano P, Pigozzo MN, Lagana DC, Sesma N. Patient outcomes and procedure working time for digital versus conventional impressions: A systematic review. J Prosthet Dent. 2018;119(2):214-9.
54. Sivaramakrishnan G, Alsobaiei M, Sridharan K. Patient preference and operating time for digital versus conventional impressions: a network meta‐analysis. Aust Dent J. 2020;65(1):58-69.
55. Skramstad M. Welcome to Cerec Primescan AC Willkommen Cerec Primescan AC. Int J Comput Dent. 2019;22(1):69-78.

Geleneksel ve Dijital Ölçülerin Dezenfeksiyon ve Sterilizasyon İşlemleri

Year 2021, Volume: 3 Issue: 2, 52 - 65, 30.06.2021

Seda Cengiz , Feyza Aksu Olcay

Abstract

Protetik diş tedavisinde kullanılan materyaller ve uygulamalar nedeniyle, protez uzmanları, yardımcı personel ve diş teknisyenleri, hastalardan bulaşabilecek birçok enfeksiyonla karşı karşıya kalmaktadır. Protetik işlemler sırasında hasta ağzından alınan ölçü maddelerinin dezenfekte edilmeden laboratuvara gönderilmesi klinik ile laboratuvar arasında çapraz kontaminasyona neden olmaktadır. Kontaminasyonun önlenebilmesi amacıyla, hastalardan alınan ölçülerin dezenfekte edilerek teknisyenlere iletilmesi önerilmektedir. Ancak kullanılacak dezenfeksiyon materyali ve yöntemleri, ölçü materyalinin özelliklerini etkileyebilmektedir. Bu derlemenin amacı, dijital ve geleneksel analog ölçülerin dezenfeksiyon ve sterilizasyon metotlarının incelenmesidir.

Keywords

dezenfeksiyon, geleneksel ölçü, dijital ölçü

References

1. al-Omari WM, Jones JC, Hart P. A microbiological investigation following the disinfection of alginate and addition cured silicone rubber impression materials. Eur J Prosthodont Restor Dent. 1998;6(3):97-101.
2. Drennon DG, Johnson GH, Powell GL. The accuracy and efficacy of disinfection by spray atomization on elastomeric impressions. J Prosthet Dent. 1989;62(4):468-75.
3. Westerholm HS, 2nd, Bradley DV, Jr., Schwartz RS. Efficacy of various spray disinfectants on irreversible hydrocolloid impressions. Int J Prosthodont. 1992;5(1):47-54.
4. Taylor RL, Wright PS, Maryan C. Disinfection procedures: their effect on the dimensional accuracy and surface quality of irreversible hydrocolloid impression materials and gypsum casts. Dent Mater. 2002;18(2):103-10.
5. Egusa H, Watamoto T, Matsumoto T, Abe K, Kobayashi M, Akashi Y, et al. Clinical evaluation of the efficacy of removing microorganisms to disinfect patient-derived dental impressions. Int J Prosthodont. 2008;21(6):531-8.
6. Kotsiomiti E, Tzialla A, Hatjivasiliou K. Accuracy and stability of impression materials subjected to chemical disinfection - a literature review. J Oral Rehabil. 2008;35(4):291-9.
7. Külekçi G. Dişhekimliğinde bulaşabilir enfeksiyonlar. Dişhekimliğinde Klinik 2000; 13: 69-76.
8. Georgescu CE, Sakaug N, Patrascu I. Cross Infection in Dentistry. Roum Biotechnol Lett 2002;7: 861-868.
9. Akçaboy C, Suca S. Ölçü maddeleri ve klinik uygulamaları. 1. baskı, Gazi Üniversitesi Diş Hekimliği Fakültesi, Ankara, 1993, 129-133.
10. Akpınar YZ, Uzun İH, Yılmaz B, Tatar N. Protetik tedavilerde çapraz enfeksiyon kontrolü. Atatürk Üniv. Diş Hek. Fak. Derg. 2013; Suppl 7: 142-149. 11. Al-Jabrah O, Al-Shumailan Y, Al-Rashdan M. Antimicrobial effect of 4 disinfectants on alginate, polyether, and polyvinyl siloxane impression materials. Int J Prosthodont. 2007; 20: 299-307.
12. Almortadi N, Chadwick RG. Disinfection of dental impressions - compliance to accepted standards. Br Dent J. 2010; 209: 607-611.
13. Sofou A, Larsen T, Fiehn NE, Owall B. Contamination level of alginate impressions arriving at a dental laboratory. Clin Oral Investig. 2002; 6:161-165.
14. Acar N. Diş Hekimliğinde Sterilizasyon Kontrolü ve Önemi. 5. Ulusal Sterilizasyon Dezenfeksiyon Kongresi 2007.
15. Hargreaves KM, Cohen S. RC. Pathways of the pulp. 10th ed., Mosby, St Louis, 2002, 124-134.
16. Dezenfeksiyon, Antisepsi, Sterilizasyon Derneği (DAS). Sterilizasyon Dezenfeksiyon Rehberi 2011;18-28.
17. Naylor WP. Infection control in fixed prosthodontics. Dent Clin North Am 1992; 36: 809-31.
18. Chidambaranathan AS, Balasubramanium M. Comprehensive review and comparison of the disinfection techniques currently available in the literature. J Prosthodont. 2019;28(2):849-56.
19. Arıkan S. Temizlik, dezenfeksiyon ve sterilizasyon Hastane İnfeksiyonları Dergisi. 1997; 1: 61-68.
20. Abbasoğlu U. Dezenfektanlar: Sınıflama ve Amaca Uygun Kullanım Alanları. 6. Ulusal Sterilizasyon Dezenfeksiyon Kongresi. 2009.
21. Centers for Diseases Control and Prevention: Guidelines for environmental infection control in health care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC), CDC, Atlanta GA (2003).
22. Decontamination and Disinfection. 2008 Elektronik adresi: http://ehs.columbia.edu/decon.html
23. Bhat, V., Shenoy, K., Shetty, S. Evaluation of efficacy of microwave oven irradiation in disinfection of patient derived dental cast. Int J Infect Cont. 2012;8(3):1-4.
24. Herrera, S. P., & Merchant, V. A. Dimensional stability of dental impressions after immersion disinfection. J Am Dent Assoc. 1986;113(3):419-22.
25. Chia WK, Stevens L, Basford KE, Randell DM. Dimensional change of impressions on sterilization. Aust Dent J. 1990;35(1):23-6.
26. Jagger DC, Al Jabra O, Harrison A, Vowles RW, McNally L. The effect of a range of disinfectants on the dimensional accuracy of some impression materials. Eur J Prosthodont Restor Dent. 2004;12(4):154-60.
27. Johnson GH, Chellis KD, Gordon GE, Lepe X. Dimensional stability and detail reproduction of irreversible hydrocolloid and elastomeric impressions disinfected by immersion. J Prosthet Dent. 1998;79(4):446-53.
28. Infection control recommendations for the dental office and the dental laboratory. ADA Council on Scientific Affairs and ADA Council on Dental Practice. J Am Dent Assoc. 1996;127(5):672-80.
29. Samaranayake LP, Hunjan M, Jennings KJ. Carriage of oral flora on irreversible hydrocolloid and elastomeric impression materials. J Prosthet Dent. 1991;65(2):244-9.
30. Amin WM, Al-Ali MH, Al Tarawneh SK, Taha ST, Saleh MW, Ereifij N. The effects of disinfectants on dimensional accuracy and surface quality of impression materials and gypsum casts. J Clin Med Res. 2009;1(2):81-9.
31. Ishida H, Nahara Y, Tamamoto M, Hamada T. The fungicidal effect of ultraviolet light on impression materials. J Prosthet Dent. 1991;65:532-535.
32. S. Ud Din, N. Noor, S. Humayoun, S. Khalid, S. Parker, M. Patel Tensile strength of novel experimental hydrophilic vinyl polysiloxane impression materials compared to control and commercial vps impression materials. J Islamabad Med Dent Coll. 2018;7(1):67-72.
33. T.A. Hamalian, E. Nasr, J.J. Chidiac. Impression materials in fixed prosthodontics: influence of choice on clinical procedure J Prosthodont. 2011;20:153-160.
34. U. Nassar, A. Oko, S. Adeeb, M. El-Rich, C. Flores-Mir. An in vitro study on the dimensional stability of a vinyl polyether silicone impression material over a prolonged storage period. J Prosthet Dent. 2013;109:172-178.
35. S. Chen, W. Liang, F. Chen. Factors affecting the accuracy of elastometric impression materials. J Dent. 2004;32(8):603-609.
36. K. Grundke, S. Michel, G. Knispel, A. Grundler. Wettability of silicone and polyether impression materials: characterization by surface tension and contact angle measurements. Colloids Surf A Physicochem Eng Asp. 2008;317(1-3):598-609.
37. F. Luo, G. Hong, T. Wang, L. Jia, J.-Y. Chen, L. Suo, et al. Static and dynamic evaluations of the wettability of commercial vinyl polysiloxane impression materials for artificial saliva. Dent Mater J. 2018;37(5):818-824.
38. S. Ud Din, S. Parker, M. Braden, P. Tomlins, M. Patel. Experimental hydrophilic vinyl polysiloxane (VPS) impression materials incorporating a novel surfactant compared with commercial VPS. Dent Mater J. 2017;33(8):301-309.
39. S. Younis, M. Ijaz, S. Ibrahim, A. Aslam. Wettability and hydrophillicity of vinyl polysiloxane impression material. Pak Oral Dent J. 2018;38:390-392.
40. S.V. Nimonkar, V.M. Belkhode, S. Godbole, P.V. Nimonkar, T. Dahane, S. Sathe. Comparative evaluation of the effect of chemical disinfectants and ultraviolet disinfection on dimensional stability of the polyvinyl siloxane impressions. J Int Soc Prev Community Dent. 2019;9:152.
41. X. Lepe, G.H. Johnson, J.C. Berg, T.C. Aw, G.S. Stroh. Wettability, imbibition, and mass change of disinfected low-viscosity impression materials. J Prosthet Dent. 2002;88(3):268-276.
42. A. Thomas, K. Muniandy. Absorption and desorption of water in rubbers. Polymer. 1987;28(3):408-415.
43. G. Soganci, D. Cinar, A. Caglar, A. Yagiz. 3D evaluation of the effect of disinfectants on dimensional accuracy and stability of two elastomeric impression materials. Dent Mater J. 2018;37(4):675-684.
44. E. Kotsiomiti, A. Tzialla, K. Hatjivasiliou. Accuracy and stability of impression materials subjected to chemical disinfection – a literature review. J Oral Rehabil. 2008;35(4):291-299.
45. Estafanous EW, Palenik CJ, Platt JA. Disinfection of bacterially contaminated hydrophilic PVS impression materials. J Prosthodont. 2012;21:16-21.
46. McIntosh, K., Hirsch, M. S., Bloom, A. Coronavirus disease 2019 (COVID-19). UpToDate Hirsch MS Bloom. 2020;5:1-1.
47. Vatansever F, Ferraresi C, de Sousa MVP, Yin R, Rineh A, Sharma SK. Can biowarfare agents be defeated with light? Virulence. 2013;4(8):796-825.
48. Andersen, B. M., Bånrud, H., Bøe, E., Bjordal, O., Drangsholt, F. Comparison of UV C light and chemicals for disinfection of surfaces in hospital isolation units. Infect Control Hosp Epidemiol. 2006;27(7):729-34.
49. Kohn, W. G., Collins, A. S., Cleveland, J. L., Harte, J. A., Eklund, K. J., Malvitz, D. M. Guidelines for infection control in dental health-care settings. 2003;52(17):1-61.
50. Guidelines for infection control in the dental office and the commercial dental laboratory. Council on Dental Therapeutics. Council on Prosthetic Services and Dental Laboratory Relations. J Am Dent Assoc. 1985;110(6):969-72.
51. Berg E, Nielsen O, Skaug N. High-level microwave disinfection of dental gypsum casts. Int J Prosthodont. 2005;18(6):520-5.
52. Barenghi L, Barenghi A, Cadeo C, Di Blasio AJBri. Innovation by Computer-Aided Design/Computer-Aided Manufacturing Technology: A Look at Infection Prevention in Dental Settings. Biomed Research Internatıonal. 2019;1-15.
53. Gallardo YR, Bohner L, Tortamano P, Pigozzo MN, Lagana DC, Sesma N. Patient outcomes and procedure working time for digital versus conventional impressions: A systematic review. J Prosthet Dent. 2018;119(2):214-9.
54. Sivaramakrishnan G, Alsobaiei M, Sridharan K. Patient preference and operating time for digital versus conventional impressions: a network meta‐analysis. Aust Dent J. 2020;65(1):58-69.
55. Skramstad M. Welcome to Cerec Primescan AC Willkommen Cerec Primescan AC. Int J Comput Dent. 2019;22(1):69-78.

There are 54 citations in total.

Details

Primary Language	Turkish
Subjects	Dentistry
Journal Section	Prosthodontics and Maxillofacial Prosthetics
Authors	Seda Cengiz 0000-0002-8681-0164 Feyza Aksu Olcay 0000-0002-4099-1078
Publication Date	June 30, 2021
Submission Date	May 20, 2021
Published in Issue	Year 2021 Volume: 3 Issue: 2

Cite

Vancouver	Cengiz S, Aksu Olcay F. Geleneksel ve Dijital Ölçülerin Dezenfeksiyon ve Sterilizasyon İşlemleri. Dent & Med J - R. 2021;3(2):52-65.

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